A correct diagnosis and an understanding of the
aetiology and dynamics of the processes involved in
tooth resorption is critical to effective management.
Tooth resorptions can be classified as: (1) trauma
induced; (2) infection induced; or (3) hyperplastic
invasive. Some transient trauma induced resorptions
require no treatment but must be carefully
monitored to check that there are no complicating
issues such as infection. In cases of trauma induced
replacement resorption, a multidisciplinary approach
is usually necessary to ensure an optimal long-term
solution. Infection induced tooth resorptions require
the removal of the invading micro-organisms by
endodontic therapy including intra-canal medication
which can also facilitate repair of the resorbed tooth
structure. The hyperplastic invasive tooth resorptions
pose considerable challenges in management due to
the complexity and aggressive nature of the
resorptive process. With careful case selection and
complete inactivation of resorptive tissue successful
management can be achieved.
Dental clinicians can be faced with difficult diagnostic
and treatment decisions with respect to tooth resorption.
Tooth resorption in the primary and permanent dentition
has been extensively studied and the complex processes
involved in the removal of the organic and inorganic
components of tooth structure by clastic cells continue
to evolve through basic research (for reviews see
Pierce,Dreyer et al .,Davidovitch et al .). Knowledge
gained from experimental studies and observations of
histopathological material has provided a sound basis
for the diagnosis and treatment of many tooth
resorptive processes.
The aim of this paper is to simplify for general dental
practitioners the diagnosis and clinical management of
tooth resorption by focusing on those resorptions
which do not and those which do require treatment,
and to identify other resorptions where combined or
alternative treatment is indicated. Emphasis will be
placed on preventive measures to control resorption,
particularly following luxation and avulsion injuries.
These important preventive measures rely on a
recognition of healing responses which are possible in
each particular clinical situation. It is the legacy of the
research of Andreasen and co-workers that responses
to a variety of traumatic injuries have been so
thoroughly analysed as to make the management of
dental injuries predictable and usually highly successful.
The latest edition of Textbook and Color Atlas of
Traumatic Injuries to the Teeth , or Traumatic Dental
Injuries; A Manual are highly recommended for all
dental practitioners. Successful management of potential
or established resorption in a dentally traumatized
patient is of paramount importance, as it has been
recognized that poorly treated injuries can have not
only physical consequences but also a significant
psychological impact on the patient.
When a patient presents with tooth resorption, the
following basic questions must be addressed in arriving
at a diagnosis and treatment plan:
(1) What type of resorption is present?
(2) Is the resorption external (periodontally
derived), internal (pulpally derived) or
communicating?
(3) Will the resorptive process be self-limiting or
transient and not require management other than
careful monitoring of healing processes?
(4) If the resorptive process is progressive will there
be a favourable response to treatment and, if so,
what is the appropriate therapy?
(5) If treated what are the short and long-term
prognoses?
(6) When is extraction and prosthetic therapy
indicated?